title: The complex interplay between delirium, sedation, and early mobility during critical illness: applications in the trauma unit.
abstract: OBJECTIVE
  Critically ill patients are prescribed sedatives and analgesics to decrease pain and anxiety, improve patient-ventilator dyssynchrony and ensure patient safety. These medications may themselves lead to delirium and ICU-acquired weakness, which are associated with worse clinical outcomes. This review will focus on the epidemiology of these two disease processes and discuss strategies aimed at reducing these devastating complications of critical illness.
  
  
  RESULTS
  Delirium and ICU-acquired weakness are associated with longer hospital stay, increased cost and decreased quality of life after discharge from the ICU. Delirium has also shown to be associated with increased mortality. Strategies aimed at reducing sedative exposure through protocols and coordination of daily sedation and ventilator cessation trials, avoiding benzodiazepines in favor of alternative sedative regimens and early mobilization of patients have all shown to significantly improve patient outcomes.
  
  
  CONCLUSIONS
  Delirium and ICU-acquired weakness are complications of critical illness associated with worse clinical outcomes and functional decline in survivors. An evidence-based approach based on the following tenets - minimization of sedative medication, particularly benzodiazepines, delirium monitoring and management and early mobilization may mitigate these complications.
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Arna
authors.initials: A
authors.lastname: Banerjee
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: Pratik
authors.initials: P
authors.lastname: Pandharipande
mesh_terms: D016292:Procedural Sedation; D016638:Critical Illness / Q000523:psychology / Q000628:therapy*; D003693:Delirium / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004434:Early Ambulation; D006757:Hospital Units; D006801:Humans; D018908:Muscle Weakness / Q000209:etiology; D010346:Patient Care Management; D012307:Risk Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*